Three Week Program Tuesdays, Wednesdays and Thursdays
6/06, 6/07, 6/08 6/13, 6/14, 6/15 6/20, 6/21, 6/22
Call Garry for Details or pricing questions.
Each player must be registered individually.
Price$399.00
Spaces 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Today's Date *
First Name *
Last Name *
Address *
City/Town *
State/County *
Zip/Post Code *
Father's Name *
Mother's Name *
Player's Phone *
Home Phone
Father's Cell *
Mother's Cell *
Emergency Phone
Email Address *
Date of Birth *
Height
Weight
Gender * Select Gender... Male Female
Present School Name
Present School Grade * Select Grade... 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Other
Hockey Experience Select Experience Level... None Less than 1 year 1-3 years 3-5 years 5+ years
Current Team(s), if any?
Position Played, if any?
Health Insurance Company *
Have you skated with Garry before? Select ... Yes No
If Yes, where did you last attend class (city and rink)
If Yes, when did you last attend (month/year)
How did you hear about us? Select... Brochure Friend Relative Coach Advertisement Facebook Youtube Surfing Online Other
Medical & Liability Release *
Concussion Form *